Waste Not
New Frontiers in Sustainable Healthcare

While scientists have long documented the impacts of climate change, the summer of 2023 made it clear that our world is literally changing. The western United States has dealt with drought and wildfires for decades but unexpectedly experienced its first hurricane in generations. The increasing frequency and severity of weather events in the southeast have led to markets where consumers struggle to afford property insurance, while insurers are challenged to adequately spread the risk associated with annual hurricane losses. The Midwest and Northeast found their communities shrouded in smoke from record-breaking Canadian wildfires; and Maui burned to the ground. Everywhere in between, the United States and the world experienced the hottest summer on record — with numerous communities feeling the impact of extreme heat for extended durations.

Perhaps this will be the tipping point where we collectively decide to make sustainability a permanent part of our mindset, lifestyle and business model. As pillars of their local communities, healthcare organizations have long been committed to “first, do no harm” and are now being asked to embrace sustainability as a social determinant of health. The pressure is coming from all directions — associates, patients, community leaders, external investors and the federal government.

It's no secret that hospitals are high-acuity buildings with many different technologies consuming significant amounts of energy in the provision of care. Most healthcare facilities have established energy-efficiency programs over the last two decades to reduce consumption (and operating expenses). However, every facility will eventually reach the point of diminishing returns for new investments, where they begin to approach the minimum amount of energy required to operate the physical environment.

This is why many leading organizations have already made the transition from an energy-efficiency approach to a carbon-management program. A hospital’s carbon footprint encompasses more than infrastructure optimization and lighting retrofits. While fossil fuel consumption is still a primary driver, it also requires organizations to consider potent greenhouse gas (GHG) emissions — from refrigerants, anesthetic gases and methane emissions from organic waste sent to landfills. It also extends the focus beyond infrastructure such as boilers, chillers and backup generators to renewable energy procurement, fleet vehicles and vendor emissions. It is an exciting new frontier that requires innovation and collaboration to minimize emissions without impacting the quality of patient-care environments.

Getting started is easy

The first step on this journey is collecting data and identifying gaps where data availability or quality could be improved. Calculating an organization’s carbon footprint is critical to understanding where there is the most opportunity for improvement. There are several free tools available to make these calculations; it’s a matter of committing time and effort to collect the data, implement the tools and analyze the results.

This information can further identify short-term opportunities, long-term gaps and the financial implications of carbon-reduction efforts. For example, natural gas is an efficient and relatively inexpensive heating option that is frequently part of an organization’s scope 1 footprint. Ultimately, these carbon emissions will need to be eliminated or offset; but options such as hydrogen or direct carbon capture are not yet cost-effective and scalable. This would indicate that the facility needs to place this item in the latter half of its long-term plan while it tracks technology advancements and advocates for external support in this area.

Data allow healthcare sustainability teams to accurately examine and prioritize short-term options so the environmental impact can be made in the most organized, cost-effective way. This is especially vital as healthcare systems are currently under a great deal of financial pressure. Being able to analyze where a system is, where it wants to be, and how to bridge the gap in a thoughtful way will be key to presenting new initiatives and securing funding for their execution.

How to move the needle

There is strong support for sustainability initiatives from the federal government’s Infrastructure Act and Inflation Reduction Act, which are allowing many healthcare facilities to take advantage of grants and direct pay incentives to improve their return on investment. On-site renewable energy installations (such as solar panels), electric-vehicle purchases or retro-commissioning investments are an excellent option for most healthcare facilities, and could be eligible for subsidies. The US Department of Health and Human Services’ Office of Climate Change and Health Equity has even published a “Quickfinder for Leveraging the IRA for the Health Sector” to help facilitate the process.

Organic waste is a substantial emitter of GHGs. Practice Greenhealth estimates that 10-15 percent of the waste an average hospital creates is food waste — a total of more than 288,400 tons of waste sent to landfills annually. Installing equipment such as food-waste digesters — that capture organic matter before they reach landfills, where they slowly break down and release potent methane gas — actively counters this issue. This is a relatively low-cost implementation that has some financial benefit from reduced waste-hauling expense and could potentially minimize the risk of associated injuries, depending on current environmental-services disposal processes.

The three most common halogenated, inhalational anesthetics used for surgery — isoflurane, sevoflurane and desflurane — are recognized greenhouse gases; and the healthcare industry is also working with clinical partners to reduce emissions. This includes reducing consumption, taking into account the associated leakage that comes with their delivery; and transitioning to anesthetics that emit less potent GHGs. These initiatives have documented benefits that not only reduce carbon emissions but also support high-quality patient care and reduction of operating expenses.

Healthcare facilities are extremely complex physical environments. As such, sustainability initiatives will require more planning, research and pilots to ensure organizations are safely implementing initiatives without directly impacting the provision of patient care. These measured decisions then foster collaboration among healthcare institutions. The more positive outcomes an organization has, the more it shares externally and encourages other institutions to adopt successful programs themselves. Collaboration helps accelerate implementation timelines. It provides evidence that programs work in similar environments and develops a network of peers who are committed to sustainability efforts and patient care. Whether you’re just getting started in sustainability or have been at the forefront of the industry, there is much to learn from one another to make healthcare that much more sustainable.